Pediatric Dental Procedures Research Articles

Comparison of pain perception during the administration of local anaesthesia with computerized delivery system (WAND) and conventional technique in pediatric dental procedure using Visual Analogue scale-A randomised controlled trial

PurposeThe purpose of the study was to compare the pain perception during the administration of local anaesthesia with the computerized delivery system (Wand) and conventional injection technique in paediatric dental procedures using the Visual Analogue Scale (VAS). MethodsOne hundred and six children from the OPD of Department of Pedodontics, Yerla Medical Trust Dental College, Navi Mumbai were included in the study. They were divided in to three groups: Group A-six years (5 years 6 months- 6 years 6 months), Group B- nine years (8 years 6 months–9 years 6 month), and Group C- twelve years (11 years 6 months–12 years 6 months). In each group, children received two interventions: the conventional local anaesthesia administration and WAND. Based on randomization by flip of the coin, the technique to be administered first was chosen. Palatal infiltration was always given first followed by the buccal infiltration irrespective of whether the WAND or the conventional technique was used. ResultThere was no significant difference between the mean pain perception (VAS scores) for the Wand and conventional injection technique in the 6 and 9 year old age groups. However there was significant difference between the two, among children in the 12 year age group. Conclusionthere was no difference in the pain perception measured as VAS score with reference to the two techniques compared: the Wand and conventional, in all and in 6 and 9 year old children. However, the Wand technique was found to be superior in terms of lower pain for the 12 year olds. Also, among girls, the Wand technique was found to be superior.

Assessment of photobiomodulation therapy by an 8l0-nm diode laser on the reversal of soft tissue local anesthesia in pediatric dentistry: a preliminary randomized clinical trial.

During the injection of local anesthesia in pediatric dental procedures, from the injection time until the elimination of tissue anesthesia, inevitable problems were reported. According to the encouraging results of previous studies addressing the positive effects of laser therapy on increasing the microcirculation, we aimed to investigate the clinical effect of photobiomodulation therapy on the reversal of soft tissue anesthesia in children. Using a split-mouth design, 34 children aged 4 to 8years old, candidate for receiving local infiltration injection at both right and left side in mandible, were enrolled in the study. The mandibular right and left quadrants were randomly assigned to groups of laser or sham laser: in laser side, patients received 810-nm laser irradiation, and in the sham laser group, the patients had the laser in off mode at 45min after injection with an interval of 7-10days between two sessions of each quadrant treatments. The degree of anesthesia was evaluated using the palpation technique alternately every 15min. Data were analyzed using paired sample t test and multiple linear regression test. The mean duration of anesthesia expressed in minutes was equal to 145.15 ± 23.27 and 188.82 ± 12.31 for the laser group and sham laser group, respectively. There was a significant difference in duration of anesthesia between two groups (P < 0.001). Considering the results and limitations of the present study, photobiomodulation therapy by 810-nm diode laser can be proposed as a non-invasive method in order to reduce the duration of anesthesia in pediatric patients.

A Pilot Study: Is Snoring During Pediatric Dental Procedures Indicative of Obstructive Sleep Apnea?

A Pilot Study: Is Snoring During Pediatric Dental Procedures Indicative of Obstructive Sleep Apnea?

Pain perception and efficacy of local analgesia using 2% lignocaine, buffered lignocaine, and 4% articaine in pediatric dental procedures.

BackgroundThe purpose of this study was to compare the pain perception and anesthetic efficacy of 2% lignocaine with 1:200,000 epinephrine, buffered lignocaine, and 4% articaine with 1:200,000 epinephrine for the inferior alveolar nerve block.MethodsThis was a double-blind crossover study involving 48 children aged 5–10 years, who received three inferior alveolar nerve block injections in three appointments scheduled one week apart from the next. Pain on injection was assessed using the Wong-Baker Faces pain scale and the sound eye motor scale (SEM). Efficacy of anesthesia was assessed by subjective (tingling or numbness of the lip, tongue, and corner of mouth) and objective signs (pain on probing).ResultsPain perception on injection assessed with Wong-Baker scale was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between buffered lignocaine and articaine (P = 0.041). The onset of anesthesia was lowest for buffered lignocaine, with a statistically significant difference between buffered lignocaine and lignocaine (P < 0.001). Moreover, the efficacy of local analgesia assessed using objective signs was significantly different between buffered lignocaine and lignocaine (P < 0.001) and between lignocaine and articaine.ConclusionBuffered lignocaine was the least painful and the most efficacious anesthetic agent during the inferior alveolar nerve block injection in 5–10-year-old patients.

Recovery characteristics of total intravenous anesthesia with propofol versus sevoflurane anesthesia: a prospective randomized clinical trial.

BackgroundPediatric dental procedures are performed under anesthesia because children may be uncooperative in the dental clinic due to their young age. Emergence delirium (ED), which involves a variety of behavioral disturbances that are frequently observed in children following emergence from general anesthesia, remains an unclear phenomenon. The aim of this randomized controlled trial is to compare the incidence of ED in children who underwent full mouth dental rehabilitation under either sevoflurane (SEVO) anesthesia or propofol-based total intravenous anesthesia (TIVA).Patients and methodsOne hundred and twenty children with American Society of Anesthesiologists status I–II, aged ≥3 and ≤6 years, undergoing dental rehabilitation were assigned to receive either TIVA or SEVO. ED and postoperative pain were evaluated by a blinded investigator using the Pediatric Anesthesia Emergence Delirium scale and the Face, Legs, Activity, Cry, Consolability scale every 5 min. The recovery time, satisfaction levels of parents or guardians, extubation time, duration of the operation, and type of dental procedure were also recorded.ResultsData of 116 subjects were analyzed. The incidence of ED was higher after SEVO than after TIVA (65.5 vs 3.4%, P=0.00). Greater postoperative pain was observed in the SEVO group (median 3 vs 1, P=0.000). A statistically significant, moderate correlation (rs=0.46, P<0.0001) was found between the Face, Legs, Activity, Cry, Consolability and Pediatric Anesthesia Emergence Delirium scores. A higher parental satisfaction level was observed in the TIVA group.ConclusionA lower incidence of ED and a higher parental satisfaction level were observed after TIVA. Moreover, TIVA resulted in a more comfortable postoperative period due to reduced postoperative pain, and the extubation time and recovery time were not increased.

Aesthetic Crowns for Restoring Anterior Primary Incisors

Background: Proper treatment of carious primary teeth is of particular importance in order to prevent oral infections. This is also because primary teeth play a very important role in proper mastication and in maintaining space in the arch for the permanent teeth. Pediatric aesthetic dental procedures are often done for reconstructive or cosmetic purposes. The Hall technique is a conservative alternative treatment for carious primary molars developed by Dr. Norna Hall in the 1980s. Aim: The aim of the present study was to evaluate the effectiveness of acrylic crown to restore carious maxillary primary incisor, following the Hall technique guide, with clinical follow-ups carried out after 3, 6 and 12 months. Materials and Methods: Ten healthy children aged 2-4 years of both genders, with extensive carious maxillary incisors were involved in this study. Acrylic crown was performed to restore carious incisor without caries removal. Instructions on oral hygiene and appliance maintenance were given to the parents. Results: Fracture of the crowns was not reported in the cases recorded during any of the recall visits. Retention of the crowns was observed to be good in 100% (N=10) of the cases during the 3, 6 and 12 months follow-up, whereas only 10% of the cases showed poor retention at the 6 months follow-up, that needed re-cementing. Based on the statistical analysis, parental satisfaction was observed to have significantly increased with the progression of time for all the considered parameters. Conclusion: The study leads to the conclusion that the simple technique of aesthetically restoring the carious primary maxillary incisors allows it to be used in daily clinical practice with a higher rate of success and satisfaction to the child and parent.

Community Health Centre-Based Outreach Clinic for undergraduate dental education: Experience in Helsinki over 8years.

The University Dental Clinic of the City of Helsinki (UDC) developed a Community Health Centre-Based Outreach Clinic, with emphasis on paediatric dentistry. This study aimed to summarise the experiences and explore the student perspectives of the health centre-based outreach teaching clinic. The study data were from the years 2010 to 2016. The dental procedures carried out by the third- to fifth-year dental students were based on electronic health record of patients. The students' self-perceived benefits and free-text comments on the outreach training were collected as part of a yearly questionnaire survey. A vast majority of the paediatric dental procedures that are required for competencies of dental students were performed in the outreach clinic. The most common procedures were fillings with local anaesthesia followed by preventive procedures. The majority of the students were very motivated to participate in the outreach training and reported that it was a useful educational approach to broaden their understanding of oral diseases and clinical experience. The outreach clinic gives dental students a chance to gain valuable clinical experience through the number and diversity of the dental procedures they carry out. They gain confidence and get an opportunity to get acquainted with the primary healthcare system and social determinants of oral diseases. Outreach appears to provide complementary clinical experiences that fulfil learning outcomes. Learning objectives should be taken into account when planning the outreach programme in order to offer meaningful and motivating education.

Intraoral topical anaesthesia in pediatric dentistry: review

Topical or surface anaesthesia is an important prerequisite for many pediatric dental procedures. Pediatric dentist/dentist should give serious thought to the type of topical and local anaesthesia administered before, during, and after the procedure. Depending on invasiveness of the dental procedure, it is imperative that the clinician choose the best anaesthesia for the job at hand. Clinician should be well versed with type, duration, quantity of topical anaesthesia to be administered in achieving maximum efficiency, without the risk of toxicity. The aim of this review is to provide an insight about topical anaesthetics and their application in various intraoral operative procedures with a special focus on applications in pediatric dentistry, including specific clinical recommendations.

Effects of music on sedation depth and sedative use during pediatric dental procedures

Study objectiveThe study aimed to investigate the effects of listening to music or providing sound isolation on the depth of sedation and need for sedatives in pediatric dental patients. DesignProspective, randomized, and controlled study. SettingTertiary, university hospital. PatientsIn total, 180 pediatric patients, American Society of Anesthesiologists physical status I and II, who were scheduled for dental procedures of tooth extraction, filling, amputation, and root treatment. InterventionsPatients were categorized into 3 groups: music, isolation, and control. During the procedures, the patients in the music group listened to Vivaldi’s The Four Seasons violin concertos by sound-isolating headphones, whereas the patients in the isolation group wore the headphones but did not listen to music. All patients were sedated by 0.1 mg/kg midazolam and 1 mg/kg propofol. During the procedure, an additional 0.5 mg/kg propofol was administered as required. Measurements and main resultsBispectral index was used for quantifying the depth of sedation, and total dosage of the propofol was used for sedative requirements. The patients’ heart rates, oxygen saturations, and Observer’s Assessment of Alertness and Sedation Scale and bispectral index scores, which were monitored during the operation, were similar among the groups. In terms of the amount of propofol used, the groups were similar. Prolonged postoperative recovery cases were found to be significantly frequent in the control group, according to the recovery duration measurements (P = .004). ConclusionsListening to music or providing sound isolation during pediatric dental interventions did not alter the sedation level, amount of medication, and hemodynamic variables significantly. This result might be due to the deep sedation levels reached during the procedures. However, listening to music and providing sound isolation might have contributed in shortening the postoperative recovery duration of the patients.

Addition of dexamethasone–chlorpheniramine mixture reduces the incidence of vomiting associated with oral ketamine premedication after pediatric dental procedures

Background Oral ketamine has been shown to induce safe and effective sedation in children, but with a high incidence of postoperative vomiting. Vendexine (dexamethasone–chlorpheniramine mixture) is a commercially available syrup used primarily to treat allergic conditions. Each of its components has antiemetic effects. In the present study, we aimed to determine whether the addition of vendexine to oral ketamine premedication affects the incidence of postoperative vomiting. Patients and methods Sixty-four children scheduled for elective dental procedures under general anesthesia were enrolled in this prospective, randomized, double-blind study. They received an oral premedication mixture (total volume of 0.42 ml/kg) of either ketamine 6 mg/kg (0.12 ml/kg) mixed with dextrose 50% and apple juice (the K group), or ketamine 6 mg/kg (0.12 ml/kg) mixed with dextrose 50% and vendexine syrup (0.25 ml/kg) (the VK group). Sedation onset was noted. Scores for drug acceptance, sedation, emotional status, and behavior during parents’ separation, on venipuncture, and face mask application were rated. Incidence of postoperative vomiting, emergence agitation score, fentanyl consumption, and recovery time were also recorded. Results The two groups were comparable as regards sedation onset, scores for drug acceptance, sedation, emotional status, and behavior during parents’ separation, on venipuncture, and face mask application. However, a significant reduction of postoperative vomiting in the VK group was noticed compared with the K group (9.3 vs. 37.5%). In addition, emergence agitation and fentanyl consumption were significantly reduced in the VK group. Conclusion Vendexine added to oral ketamine reduces the incidence of postoperative vomiting associated with ketamine premedication in children.

An Evaluation of Intranasal Sufentanil and Dexmedetomidine for Pediatric Dental Sedation

Conscious or moderate sedation is routinely used to facilitate the dental care of the pre- or un-cooperative child. Dexmedetomidine (DEX) has little respiratory depressant effect, possibly making it a safer option when used as an adjunct to either opioids or benzodiazepines. Unlike intranasal (IN) midazolam, IN application of DEX and sufentanil (SUF) does not appear to cause much discomfort. Further, although DEX lacks respiratory depressive effects, it is an α2-agonist that can cause hypotension and bradycardia when given in high doses or during prolonged periods of administration. The aim of this feasibility study was to prospectively assess IN DEX/SUF as a potential sedation regimen for pediatric dental procedures. After IRB approval and informed consent, children (aged 3–7 years; n = 20) from our dental clinic were recruited. All patients received 2 μg/kg (max 40 μg) of IN DEX 45 min before the procedure, followed 30 min later by 1 μg/kg (max 20 μg) of IN SUF. An independent observer rated the effects of sedation using the Ohio State University Behavior Rating Scale (OSUBRS) and University of Michigan Sedation Scale (UMSS). The dentist and the parent also assessed the efficacy of sedation. Dental procedures were well tolerated and none were aborted. The mean OSUBRS procedure score was 2.1, the UMSS procedure score was 1.6, and all scores returned to baseline after the procedure. The average dentist rated quality of sedation was 7.6 across the 20 subjects. After discharge, parents reported one child with prolonged drowsiness and one child who vomited at home. The use of IN DEX supplemented with IN SUF provided both an effective and tolerable form of moderate sedation. Although onset and recovery are slower than with oral (PO) midazolam and transmucosal fentanyl, the quality of the sedation may be better with less risk of respiratory depression. Results from this preliminary study showed no major complications from IN delivery of these agents.

Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children.

ABSTRACTAim: The present study was taken up to clinically evaluate and compare effectiveness of transcutaneous electrical nerve stimulator (TENS) and comfort control syringe (CCS) in various pediatric dental procedures as an alternative to the conventional method of local anesthesia (LA) administration.Materials and methods: Ninety healthy children having at least one deciduous molar tooth indicated for extraction in either maxillary right or left quadrant in age group of 6 to 10 years were randomly divided into three equal groups having 30 subjects each. Group I: LA administration using conventional syringe, group II: LA administration using TENS along with the conventional syringe, group III: LA administration using CCS. After LA by the three techniques, pain, anxiety and heart rate were measured.Statistical analysis: The observations, thus, obtained were subjected to statistical analysis using analysis of variance (ANOVA), student t-test and paired t-test.Results: The mean pain score was maximum in group I followed by group II, while group III revealed the minimum pain, where LA was administered using CCS. Mean anxiety score was maximum in group I followed by group II, while group III revealed the minimum score. Mean heart rate was maximum in group I followed in descending order by groups II and III.Conclusion: The study supports the belief that CCS could be a viable alternative in comparison to the other two methods of LA delivery in children.How to cite this article: Bansal N, Saha S, Jaiswal JN, Samadi F. Pain Elimination during Injection with Newer Electronic Devices: A Comparative Evaluation in Children. Int J Clin Pediatr Dent 2014;7(2):71-76.

Trends in death associated with pediatric dental sedation and general anesthesia

Inadequate access to oral health care places children at risk of caries. Disease severity and inability to cooperate often result in treatment with general anesthesia (GA). Sedation is increasingly popular and viewed as lower risk than GA in community settings. Currently, few data are available to quantify pediatric morbidity and mortality related to dental anesthesia. Summarize dental anesthesia-related pediatric deaths described in media reports. Review of media reports in the Lexis-Nexis Academic database and a private foundation website. Dental offices, ambulatory surgery centers, and hospitals. Patients :US-based children (≤21years old) who died subsequently receiving anesthesia for a dental procedure between 1980-2011. Most deaths occurred among 2-5year-olds (n=21/44), in an office setting (n=21/44), and with a general/pediatric dentist (n=25/44) as the anesthesia provider. In this latter group, 17 of 25 deaths were linked with a sedation anesthetic. This series of media reports likely represent only a fraction of the overall morbidity and mortality related to dental anesthesia. These data may indicate an association between mortality and pediatric dental procedures under sedation, particularly in office settings. However, these relationships are difficult to test in the absence of a database that could provide an estimate of incidence and prevalence of morbidity and mortality. With growing numbers of children receiving anesthesia for dental procedures from providers with variable training, it is imperative to be able to track anesthesia-related adverse outcomes. Creating a national database of adverse outcomes will enable future research to advance patient safety and quality.

Safety of oral midazolam sedation use in paediatric dentistry: a review

Little information is available as to the safety of midazolam when used as an oral sedative. To evaluate the side effects and other adverse outcomes following use of oral midazolam for behaviour management in paediatric dentistry. A review of published literature relating to the safety and side effects of oral midazolam for use in paediatric dental procedures was conducted. Both randomised controlled trials and non-randomised studies were assessed. Reported side effects were recorded and classified as either significant or minor. The percentage prevalence of significant or minor side effects per episode of treatment was calculated. Sixteen papers of randomised controlled trials met the inclusion criteria. None of the side effects recorded were considered as significant. Minor side effects were reported (n=68, 14%), with nausea and vomiting being the most frequently recorded (n=30, 6%). Eleven papers of non-randomised studies were included. No significant side effects were recorded. Minor side effects were recorded (n=157, 8%), with paradoxical reaction being the most common at 3.8%. Significant side effects associated with oral midazolam usage for behaviour management in children and adolescents requiring dental treatment appear to be rare. Minor side effects are more common but determining precise figures is complicated by poor reporting.

Comparison of the pain perception in children using comfort control syringe and a conventional injection technique during pediatric dental procedures

To evaluate and compare the pain perception by the pediatric patients, while experiencing computerized injection device comfort control syringe (CCS) and the conventional injection technique during dental clinical procedures. Fifty children (31 boys and 19 girls) aged 6-14 years requiring local anaesthesia on both sides of the dental arch for various treatment procedures were selected for this study. The patients served as their own control, and on the appointed day CCS was used on one side of the dental arch and on the subsequent appointment, i.e., the very next day conventional injection technique was used. Visual analogue scale (VAS) and faces pain rating scale (FRS) were used to assess the child's pain perception to each of the techniques immediately after the injection. Various physiological parameters were measured before, during and after the two injection procedures and compared for statistical variation. Paired t-test revealed a statistically significant difference in the pain perception by children using VAS and FRS between computerized and conventional technique. No statistically significant difference was observed when physiological parameters (heart rate, blood pressure and temperature) were compared at various intervals between the computerized and the conventional technique. Computerized injection device (CCS) provides less painful injections when compared to the conventional injection technique.

Comparative evaluation of the effectiveness of electronic dental anesthesia with 2% lignocaine in various minor pediatric dental procedures: A clinical study

One of the most distressing aspects of dentistry for pediatric patients is the fear and anxiety caused by the dental environment, particularly the dental injection. The application and induction of local anesthetics has always been a difficult task, and this demands an alternative method that is convenient and effective. Electronic dental anesthesia, based on the principal of transcutaneous electric nerve stimulation (TENS), promises to be a viable mode of pain control during various pediatric clinical procedures. Therefore, the aim of the present study was to evaluate the effectiveness of TENS and to compare its efficacy with 2% lignocaine during various minor pediatric dental procedures. Pain, comfort and effectiveness of both the anesthetics were evaluated using various scales and no significant difference was observed between 2% lignocaine and TENS in the various pain scales, while TENS was perceived to be significantly effective in comfort and efficacy as judged by the operator and quite comfortable as judged by the patient himself/herself.

Paediatric dentistry in outreach settings: an essential part of undergraduate curricula?

Although placements in primary care settings remote from dental schools are becoming a common feature of undergraduate dental curricula, little evidence is available regarding the experience of paediatric dentistry gained in this way. Treatment logs relating to salaried primary care placements undertaken by the Class of 2007 at Cardiff University School of Dentistry were examined, particular attention being paid to paediatric-specific procedures. Forty-nine logs relating to placements undertaken in South East Wales and 51 relating to those in North Wales were retrieved. In South East Wales, 90% of students gained experience of primary tooth restoration, 61% carrying out primary endodontics. Sixty-three percent of students undertaking placements in South East Wales and 69% of those placed in North Wales gained experience of primary tooth extraction under local anaesthesia. All but three students gained experience of administering inhalation sedation. The findings of this study should go some way towards reassuring those who have expressed concern that recruitment difficulties within dental schools inevitably lead to increasing numbers of students qualifying without clinical experience of paediatric dental procedures considered to be within the remit of a newly qualified dental practitioner. However, there remains wide variation in the breadth and depth of experience of individual students and it is still possible for some students to graduate without what might be considered core experience in paediatric dentistry. Salaried primary care settings are ideally placed to provide students with experience of paediatric-specific procedures. Clinical education in paediatric dentistry should, therefore, incorporate the strengths of dental school and placement education.

Quality of recovery from two types of general anesthesia for ambulatory dental surgery in children: a double‐blind, randomized trial

Pediatric dental procedures are increasingly performed under general anesthesia because of the inability to cooperate, situational anxiety, or other behavioral problems. Volatile anesthetics have been associated with emergence delirium in children, whereas the use of propofol for anesthetic maintenance has been shown to reduce the incidence of emergence delirium after other types of surgeries. The aim of this study is to compare a sevoflurane-based anesthetic with a propofol-based technique as it relates to the incidence of emergence delirium and the quality of recovery after pediatric dental surgery, in patients who present with risk factors for perioperative behavioral issues. We prospectively collected data of 179 pediatric patients scheduled for ambulatory dental surgery using a double-blind and randomized trial design. Subjects were anesthetized following standardized protocols for either a sevoflurane- or a propofol-based technique. The incidence of emergency delirium, as measured by the Pediatric Anesthesia Emergence Delirium score, was the primary outcome. Secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), number of nursing interventions in the recovery room, time to discharge readiness, and parental satisfaction. We found no difference in the incidence of emergence delirium after both types of anesthesia. However, use of sevoflurane significantly increased both the risk of PONV and the number of postoperative nursing interventions. Discharge criteria were met about 10 min earlier in patients anesthetized with sevoflurane. Parental satisfaction was equally high with both anesthesia regimens. A propofol-based anesthetic technique did not lead to a lower incidence of emergence delirium after dental surgery in children but did result in significantly less PONV and fewer postoperative nursing interventions.

Rethinking the Role of Community‐Based Clinical Education in Pediatric Dentistry

The early childhood caries epidemic has prompted a look at predoctoral clinical dental education in pediatric dentistry. The purpose of this study was to examine the contribution of community-based clinical education (CBE) to procedural and patient diversity in predoctoral pediatric dental education. Using procedural and demographic data from pediatric clinical experiences of the dental class of 2007 at The Ohio State University College of Dentistry, profiles of patient diversity, clinical pediatric dental procedures, and student efficiency were developed for both CBE sites and the campus-based clinic. Ninety-two students performed 16,523 procedures on children in the fourth year in CBE sites in the community compared to 4,268 on campus in their third year. Pediatric-dedicated CBE sites accounted for almost 12,000 pediatric dental procedures. Approximately 56 percent of children treated at CBE sites were minorities. CBE sites accounted for most of the dental student restorative experience for pediatric patients for the Class of 2007, giving each student on average multiple restorative procedures. The campus-based clinic provided largely diagnostic and preventive procedures but few restorative opportunities. We conclude that community-based dental clinical education presents an opportunity to enhance pediatric predoctoral student clinical experiences in both quantity and diversity.

The effect of a community dental service outreach programme on the confidence of undergraduate students to treat children: a pilot study

To examine the effect of a community dental service (CDS) outreach teaching programme on undergraduates' confidence to undertake a range of paediatric dental procedures. Eighteen final year dental students completed a questionnaire prior to, and following participation in an outreach teaching programme. At each time point, the students were asked to identify how confident they felt to carry out a range of procedures commonly encountered in the treatment of children, employing a Likert scale modified to comprise six points where a rating of 1 represented 'not at all confident' and a rating of 6 'very confident'. The distribution of scores at each time point indicated that students were more confident to carry out each of the listed procedures following participation in the outreach teaching programme than they had been on completion of their paediatric dentistry sessions within the School of Dentistry. At the individual student level, 16 of the 18 students indicated that they were, overall, more confident following their placement than previously. It can be concluded that the long-established CDS outreach teaching programme run by the School of Dentistry, Wales College of Medicine in conjunction with the staff of Cardiff and Vale NHS Trust is a valuable adjunct to undergraduate teaching in paediatric dentistry.